Duoc Ly - 5.Khang Sinh

8/9/2019 Duoc Ly - 5.Khang Sinh

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THUOC KHANG SINHTHUOC KHANG SINH


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M AUM AU

Khi vi khuan xam nhap vao c the, neuKhi vi khuan xam nhap vao c the, neuchung vt qua c he thong mien dchchung vt qua c he thong mien dchva bat au sinh san, khi o vi khuan seva bat au sinh san, khi o vi khuan segay benh.gay benh.

Cac vi khuan gay benh sinh ra oc to gayCac vi khuan gay benh sinh ra oc to gayton thng cac c quan trong c the.ton thng cac c quan trong c the.

Khang sinh co kha nang tieu diet viKhang sinh co kha nang tieu diet vikhuan.khuan.

Hieu qua cua khang sinh khac nhau oiHieu qua cua khang sinh khac nhau oivi cac chung vi khuan khac nhau.vi cac chung vi khuan khac nhau.


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Khang sinh co nhieu nguon gocKhang sinh co nhieu nguon gockhac nhau: vi khuan, vi nam,khac nhau: vi khuan, vi nam,

actinomycetes, cac chat ban tong hpactinomycetes, cac chat ban tong hpva tong hp.va tong hp.


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Lch s phat trien khangLch s phat trien khang

sinhsinh Nam 1928, nha sinh vat hoc ngiNam 1928, nha sinh vat hoc ngiScottland la Alexander Fleming thayScottland la Alexander Fleming thayrang Penicillium notatum ( mot loairang Penicillium notatum ( mot loai

nam) co kha nang tieu diet vinam) co kha nang tieu diet vikhuan Staphylococcus trong luc angkhuan Staphylococcus trong luc angnuoi cay.nuoi cay.

Nha hoa hoc ngi c Paul EhrlichNha hoa hoc ngi c Paul Ehrlichnhan thay rang mot so chat conhan thay rang mot so chat cokha nang tieu diet vi khuan gaykha nang tieu diet vi khuan gaybenh ma khong anh hng en cbenh ma khong anh hng en c

the ngi.the ngi.


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Sir Alexander FlemingSir Alexander Fleming


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Flemings Petri DishFlemings Petri Dish


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-- Nam 1939 the he Penicilline auNam 1939 the he Penicilline au

tien ra i.tien ra i.-- en nam 1944 Selman Waksman vaen nam 1944 Selman Waksman vaAlbert Schatz nha vi sinh hoc ngiAlbert Schatz nha vi sinh hoc ngi

My phan lap c treptomycin vaMy phan lap c treptomycin vamot so loai khang sinh khac tmot so loai khang sinh khac tstreptomyces griseusstreptomyces griseus


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C che hoat ong cua khangC che hoat ong cua khang

sinhsinhKhang sinh hoat ong theo 4 c cheKhang sinh hoat ong theo 4 c che

khac nhau:khac nhau:

1.1. c che s tong hp vach te baoc che s tong hp vach te bao(bacitracin, cephalosporin, cycloserin,(bacitracin, cephalosporin, cycloserin,penicillin, ristocetin, vancomycin)penicillin, ristocetin, vancomycin)

2.2.L

am thay oi kha nang tham thauL

am thay oi kha nang tham thaucua mang te bao (amphotericin B,cua mang te bao (amphotericin B,colistin, imidazoles, nystatin, polymyxins)colistin, imidazoles, nystatin, polymyxins)


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C che hoat ong cua khangC che hoat ong cua khang

sinhsinh3. c che s tong hp protein3. c che s tong hp protein

(chloramphenicol, erythromycin, lincomycin,(chloramphenicol, erythromycin, lincomycin,

tetracycline, aminoglycosides: amikacin,tetracycline, aminoglycosides: amikacin,gentamicin, kanamycin, neomycin,gentamicin, kanamycin, neomycin,streptomycin, tobramycin,).streptomycin, tobramycin,).

4. c che s tong hp acid nucleic4. c che s tong hp acid nucleic(quinolones, novobiocin, pyrimethamine,(quinolones, novobiocin, pyrimethamine,rifampin, sulfonamides, trimethoprim)rifampin, sulfonamides, trimethoprim)


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Vi khuan nhay cam va eVi khuan nhay cam va ekhang khang sinhkhang khang sinh

ieu tr nhiem trung thanh cong daieu tr nhiem trung thanh cong davao:vao:

Lieu dung: phai tao ra c nong oLieu dung: phai tao ra c nong othuoc trong mau u e tieu diet vithuoc trong mau u e tieu diet vikhuan. (Nong o khang sinh tai v trkhuan. (Nong o khang sinh tai v trnhiem trung u e c che s phatnhiem trung u e c che s phat

trien cua vi khuan hay khong).trien cua vi khuan hay khong). Tuy nhien nong o thuoc phai thapTuy nhien nong o thuoc phai thap

hn ngng gay oc cho c the.hn ngng gay oc cho c the.


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Neu nong o thuoc thoa 2 ieu trenNeu nong o thuoc thoa 2 ieu tren

va thuoc co kha nang diet vi khuanva thuoc co kha nang diet vi khuanth vi khuan nhay cam vi thuoc o.th vi khuan nhay cam vi thuoc o.

Neu nong o thuoc co kha nangNeu nong o thuoc co kha nang

tieu diet vi khuan ma vi khuantieu diet vi khuan ma vi khuankhong b tieu diet hoac ch khi khong b tieu diet hoac ch khi nong o gay oc cho c the minong o gay oc cho c the mitieu diet c vi khuan th co thetieu diet c vi khuan th co thexem la vi khuan e khang thuoc.xem la vi khuan e khang thuoc.


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S e khangS e khang

Vi khuan tao ra ezyme be mat teVi khuan tao ra ezyme be mat tebao gay bat hoat thuoc.bao gay bat hoat thuoc.

Ngan chan s khuech tan qua mangNgan chan s khuech tan qua mangte bao cua thuoc.te bao cua thuoc.

Thay oi cau truc cua v tr ket hpThay oi cau truc cua v tr ket hp

thuoc.thuoc. Thay oi ng chuyen hoa.Thay oi ng chuyen hoa.


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S e khangS e khang

Vi khuan truyen lai gen khang thuocVi khuan truyen lai gen khang thuoccho cac the he sau (theo chieu doc).cho cac the he sau (theo chieu doc). Thng gap: vi khuan truyen cacThng gap: vi khuan truyen cac

ac tnh khang thuoc cho cac viac tnh khang thuoc cho cac vikhuan khac bang cach chuyenkhuan khac bang cach chuyendang (transformation), chuyen napdang (transformation), chuyen nap(transduction) hoac tiep hp(transduction) hoac tiep hp(conjugation).(conjugation).

Bang cach nay vi khuan nhanhBang cach nay vi khuan nhanhchong tao ra dong vi khuan khangchong tao ra dong vi khuan khangthuoc va tryen ac tnh khangthuoc va tryen ac tnh khang

thuoc cho cac chung vi khuan khac.thuoc cho cac chung vi khuan khac.


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S la chon khang sinhS la chon khang sinh

Can co kien thc ve lam sang,Can co kien thc ve lam sang,dc ly va vi sinh.dc ly va vi sinh.

Khi au ieu tr theo kinh nghiemKhi au ieu tr theo kinh nghiem(cha xac nh c vi khuan gay(cha xac nh c vi khuan gaybenh) thng dung 1 loai khang sinhbenh) thng dung 1 loai khang sinhpho rong.pho rong.

ieu tr theo khang sinh o: xac nhieu tr theo khang sinh o: xac nhc loai vi khuan gay benh, thngc loai vi khuan gay benh, thngla khang sinh pho hep.la khang sinh pho hep.


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PENICILLINSPENICILLINS

Penicillins cha vongPenicillins cha vong FF--lactamlactam c chec ches tao thanh cau noi peptidoglycans tao thanh cau noi peptidoglycan

cua vach te bao vi khuan (ac bietcua vach te bao vi khuan (ac bietla vi khuan gram dng)la vi khuan gram dng)

Penicillins la thuoc diet khuan nhngPenicillins la thuoc diet khuan nhngch tac ong len giai oan phan chiach tac ong len giai oan phan chiate bao.te bao.

Thuoc khong gay oc cho te baoThuoc khong gay oc cho te baongi va ong vat (v te bao khongngi va ong vat (v te bao khong

co vach)co vach)


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Cau tao cua vongCau tao cua vong lactamlactam


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Cong thc cau tao cuapenicillins


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penicillinspenicillins

Penicillins kem hoa tan trong lipid vaPenicillins kem hoa tan trong lipid vakhong i qua hang rao mau nao,khong i qua hang rao mau nao,

thuoc ch i qua hang rao mau naothuoc ch i qua hang rao mau naokhi co xay ra hien tng viem (v vaykhi co xay ra hien tng viem (v vaythuoc co the s dung ieu tr viemthuoc co the s dung ieu tr viemmang nao).mang nao).

Thuoc c bai tiet di dang chaThuoc c bai tiet di dang chachuyen hoa qua than, nen giam lieuchuyen hoa qua than, nen giam lieu nhng benh nhan suy than. nhng benh nhan suy than.


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Mot so vi khuan tao ra menMot so vi khuan tao ra men lactamaselactamasenh:nh:Staphylococcus aureus,Staphylococcus aureus, HaemophilusHaemophilus

influenzae va Neisseria gonorrhoeainfluenzae va Neisseria gonorrhoea seselam mat tac dung cua penicillins dolam mat tac dung cua penicillins domen nay pha huy vongmen nay pha huy vong lactam cualactam cuathuoc.thuoc.


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Benzylpenicillin (Penicillin G)Benzylpenicillin (Penicillin G): khong on: khong onnh trong acid da day, de b pha huynh trong acid da day, de b pha huybi menbi men lactamase, ch dung banglactamase, ch dung bang

ng tiem chch.ng tiem chch.La loai penicillin hieu qua nhat nhngLa loai penicillin hieu qua nhat nhng

pho tac dung hep:pho tac dung hep: StrepptococcusStrepptococcus

pyogenes, S. pneumoniae, Neisseriapyogenes, S. pneumoniae, Neisseriameningitis hoac N. gonorrhoeae,meningitis hoac N. gonorrhoeae,treponemes, Listeria, Actinomycetes,treponemes, Listeria, Actinomycetes,ClostridiaClostridia


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Phenoxymethylpenicillin (Penicillin V)Phenoxymethylpenicillin (Penicillin V): on: onnh trong acid da day, c s dungnh trong acid da day, c s dung

bang ng uong e ieu tr nhngbang ng uong e ieu tr nhngnhiem trung nhe.nhiem trung nhe.

Thuoc tng t nh benzylpenicillinThuoc tng t nh benzylpenicillin


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AmpicillinAmpicillin: t co hieu qua tren vi khuan: t co hieu qua tren vi khuangram dng nh benzylpenicillin nhnggram dng nh benzylpenicillin nhngpho khang khuan rong hn, baopho khang khuan rong hn, bao

gom ca Strept. faecalis, Haemophilusgom ca Strept. faecalis, Haemophilusinfluenza, E. coli, Klebsiella va cacinfluenza, E. coli, Klebsiella va cacchung Proteus (ngoai cac vi khuanchung Proteus (ngoai cac vi khuana ke tren)a ke tren)

On nh trong acid da day, co the sOn nh trong acid da day, co the sdung bang ng uong hoacdung bang ng uong hoacng tiem chch.ng tiem chch.

De b pha huy bi menDe b pha huy bi men lactamaselactamase


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Flucloxacillin: on nh trong acid da day,Flucloxacillin: on nh trong acid da day,co the s dung bang ng uongco the s dung bang ng uong

va ng tiem chch.va ng tiem chch.e khang mene khang men lactamase.lactamase.

Pho khang khuan hep, thng dungPho khang khuan hep, thng dungieu tr nhiem trung do staphylococcusieu tr nhiem trung do staphylococcusaureus.aureus.


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Penicillins ieu tr staphylococciPenicillins ieu tr staphylococci

Gom cac nhom thuoc: Oxacillin,Gom cac nhom thuoc: Oxacillin,cloxacillin, dicloxacillin, naffcillin.cloxacillin, dicloxacillin, naffcillin.

Nhng nhom thuoc nay co khaNhng nhom thuoc nay co khanang ieu tr nhiem trung gay ra donang ieu tr nhiem trung gay ra dostaphylococci.staphylococci.


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Tac dung phu:Tac dung phu:

D ng (0,7% en 1%). Nen hoi tienD ng (0,7% en 1%). Nen hoi tien

s d ng trc khi s dung thuocs d ng trc khi s dung thuoccho benh nhan.cho benh nhan.

Boi nhiem (thng do Candida).Boi nhiem (thng do Candida).

Tieu chay: thng gap khi s dungTieu chay: thng gap khi s dungampicillin, ke en la amoxycillin.ampicillin, ke en la amoxycillin.

Tac dung phu hiem: tan huyet, viemTac dung phu hiem: tan huyet, viemthan.than.


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CephalosporinsCephalosporins

Thuoc nhomThuoc nhom lactam, va la nhomlactam, va la nhomdiet khuan.diet khuan.

La nhom thuoc tot thay the choLa nhom thuoc tot thay the chonhom penicillin khi can loai khang sinhnhom penicillin khi can loai khang sinhpho rong.pho rong.

Cho en nay cephalosporins co 4 theCho en nay cephalosporins co 4 the

he.he.Tieu diet vi khuan bang cach c cheTieu diet vi khuan bang cach c che

s tao vach te bao.s tao vach te bao.


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CephalosporinsCephalosporins

-- The he th 1 gom cac thuoc nh:The he th 1 gom cac thuoc nh:cefazolin,cefazolin, cefadroxil, cephalexin, cephradrin,cefadroxil, cephalexin, cephradrin,cephalothin. Tac ong manh nhat len nhomcephalothin. Tac ong manh nhat len nhomcau trung gram dng.cau trung gram dng.-- The he th 2 gom cac thuoc nh: cefaclor,The he th 2 gom cac thuoc nh: cefaclor,cefuroxime, cefamandol, cefonicide, cefoxitin,cefuroxime, cefamandol, cefonicide, cefoxitin,ceforanide. Tac dung tren vi khuan gram amceforanide. Tac dung tren vi khuan gram ammanh hn the he th 1. Co hieu qua oimanh hn the he th 1. Co hieu qua oi

vi enerobacteriaceae nhvi enerobacteriaceae nhE

. coli, KlebsiellaE

. coli, Klebsiella ,,proteus .proteus . Ngoai ra con co hieu qua oi viNgoai ra con co hieu qua oi viH influenzae and N meningtidisH influenzae and N meningtidis


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CAU TRUC PHAN T CUA CEPHALOSPORINS


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cephalosporinscephalosporins


D ng (10% en 20% benh nhan dD ng (10% en 20% benh nhan d

ng vi penicillins cung d ng ving vi penicillins cung d ng vicephalosporins).cephalosporins).

Viem cau than, suy than cap.Viem cau than, suy than cap.

Roi loan tieu hoa (khi dung bangRoi loan tieu hoa (khi dung bangng uong)ng uong)

Boi nhiem.Boi nhiem.


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AminoglycosidesAminoglycosides

C che hoat ong: thuoc ket hp viC che hoat ong: thuoc ket hp vitieu n v ribosome 30S, c che stieu n v ribosome 30S, c che s

tong hp protein cua vi khuan.tong hp protein cua vi khuan. Aminoglycosides co tac dung hiepAminoglycosides co tac dung hiep

ong vi cac khang sinh thuoc nhomong vi cac khang sinh thuoc nhombeta lactam.beta lactam.


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Thuoc kem hoa tan trong lipid, v vayThuoc kem hoa tan trong lipid, v vaykhong hap thu bang ng uong.khong hap thu bang ng uong.

S dung bang ng tiem chch.S dung bang ng tiem chch. Khong qua c hang rao mau naoKhong qua c hang rao mau nao

ngay ca khi mang nao b viem.ngay ca khi mang nao b viem.

Thuoc khong c chuyen hoa sau khiThuoc khong c chuyen hoa sau khii vao c the.i vao c the.


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Thuoc bai tiet qua than di dangThuoc bai tiet qua than di dangkhong chuyen hoa, thuoc tap trungkhong chuyen hoa, thuoc tap trungnhieu ong than gan (co the gapnhieu ong than gan (co the gapt 20 en 100 lan nong o trongt 20 en 100 lan nong o tronghuyet tng)huyet tng)

Giam thai tr ngi suy than, lamGiam thai tr ngi suy than, lam

tang nong o thuoc nhng ngitang nong o thuoc nhng ngisuy than de gay oc.suy than de gay oc.


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Vi khuan e khang thuoc bang cachVi khuan e khang thuoc bang cachtao ra ezymes pha huy thuoc hoactao ra ezymes pha huy thuoc hoacngan can s van chuyen thuoc vaongan can s van chuyen thuoc vaotrong te bao.trong te bao.


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Gentamicin: la thuoc thuoc nhomGentamicin: la thuoc thuoc nhomaminoglycosides c s dung nhieuaminoglycosides c s dung nhieunhat, tac dung chu yeu tren cac vinhat, tac dung chu yeu tren cac vikhuan gram am ai kh, v du nh cackhuan gram am ai kh, v du nh cac

vi khuan ng ruot nh:vi khuan ng ruot nh: (E

.coli,(E

.coli,Klebsiella, S. faecalis, Pseudomonas andKlebsiella, S. faecalis, Pseudomonas andProteus.)Proteus.)

oi khi c s dung ket hp vioi khi c s dung ket hp vi

khac sinh khac e ieu trkhac sinh khac e ieu trStaphylococcus aureusStaphylococcus aureus..

Thng khong co hieu qua oiThng khong co hieu qua oivivi Streptococci.Streptococci.


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Ngoai ra thuoc con c s dungNgoai ra thuoc con c s dungket hp vi cac khang sinh khac eket hp vi cac khang sinh khac eieu tr nhiem trung cha ro nguyenieu tr nhiem trung cha ro nguyennhan.nhan.

Streptomycin: la thuoc thuoc nhomStreptomycin: la thuoc thuoc nhomaminoglycosids c s dung ieu traminoglycosids c s dung ieu tr

lao (hien nay t c s dung caclao (hien nay t c s dung cacnc phat trien).nc phat trien).


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AminoglycosidesAminoglycosides Tobramycin: c dung ieu tr nhiemTobramycin: c dung ieu tr nhiem

trung do pseudomonas va nhiem trungtrung do pseudomonas va nhiem trungdo cac vi khuan e khang vido cac vi khuan e khang vi

gentamicin.gentamicin. Mot vai loai aminoglycosides v du nhMot vai loai aminoglycosides v du nh

gentamicin co the dung tai chogentamicin co the dung tai cho(thuoc m tra mat, tai).(thuoc m tra mat, tai).

Neomycin c dung ng uong eNeomycin c dung ng uong ekh trung ng tieu hoa (v du trongkh trung ng tieu hoa (v du tronghon me gan).hon me gan).


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Cac tac dung phu xay ra lien quanCac tac dung phu xay ra lien quan

en nong o thuoc trong huyet tng.en nong o thuoc trong huyet tng. Cho nen can theo doi nong o thuocCho nen can theo doi nong o thuoc

trong huyet tng nhng benh nhantrong huyet tng nhng benh nhans dung thuoc sau 2s dung thuoc sau 2--3 ngay ieu tr.3 ngay ieu tr.


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Tac dung phu chu yeu la gay ocTac dung phu chu yeu la gay occho than va gay oc cho tai (ca tiencho than va gay oc cho tai (ca tiennh va oc tai).nh va oc tai).

Cac tac dung phu khac hiem hn nhCac tac dung phu khac hiem hn nhd ng, giam bach cau, nhc c.d ng, giam bach cau, nhc c.


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MacrolidesMacrolides

Gom: erythromycin, clarithromycin,Gom: erythromycin, clarithromycin,azithromycin, spiramycin.azithromycin, spiramycin.

La nhom thuoc kiem khuan.La nhom thuoc kiem khuan. C che hoat ong: ket hp vi tieuC che hoat ong: ket hp vi tieu

n v 50S c che s tong hpn v 50S c che s tong hpprotein cua vi khuan.protein cua vi khuan.

Pho khang khuan chu yeu la viPho khang khuan chu yeu la vikhuan gram dng,khuan gram dng, Mycoplasma,Mycoplasma,LegionellaLegionella (intracellular bacterias)(intracellular bacterias)


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Erythromycin: phan phoi rong raiErythromycin: phan phoi rong raikhap c the ngoai tr nao va dchkhap c the ngoai tr nao va dchnao tuy.nao tuy.

Pho khang khuan bao gom:Pho khang khuan bao gom:Staphylococcus aureus, StreptococcussStaphylococcus aureus, Streptococcusspyogenes, S. pneumoniae, Mycoplasmapyogenes, S. pneumoniae, Mycoplasma

pneumoniae va nhiem trung Chlamydia.pneumoniae va nhiem trung Chlamydia.


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Cac thuoc macrolides the he mi nh:Cac thuoc macrolides the he mi nh:clarithromycin va azithromycin co t tacclarithromycin va azithromycin co t tacdung phu hn.dung phu hn.


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Buon non, non.Buon non, non.

D ng.D ng. Gay oc cho tai.Gay oc cho tai.

Viem gan.Viem gan.

Tng tac vi cytochrome P450 3A4 (cTng tac vi cytochrome P450 3A4 (cche).che).


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Chloramphenicol, Lincomycin,Chloramphenicol, Lincomycin,Clindamycin.Clindamycin.

C che hoat ong: bam vao tieu nC che hoat ong: bam vao tieu nv 50S ngan can s tong hp protein viv 50S ngan can s tong hp protein vikhuan.khuan.

Chloramphenicol co pho khang khuanChloramphenicol co pho khang khuanrong hn lincomycin va clindamycin.rong hn lincomycin va clindamycin.


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ClindamycinClindamycin

Clindamycin mac du co cong thcClindamycin mac du co cong thchoa hoc khac vi erythromycin nhnghoa hoc khac vi erythromycin nhngco tnh chat tng t erythromycin.co tnh chat tng t erythromycin.

Thuoc c hap thu nhanh chong vaThuoc c hap thu nhanh chong vaphan phoi khap ni trong c thephan phoi khap ni trong c thengoai tr than kinh trung ng.ngoai tr than kinh trung ng.

Thuoc ac biet co hieu qua trongThuoc ac biet co hieu qua trongieu tr nhiem trung he thong doieu tr nhiem trung he thong doS.aureus (viem tuy xng do thuocS.aureus (viem tuy xng do thuoctham nhap tot vao tuy xng) va vitham nhap tot vao tuy xng) va vi

khuan yem kh.khuan yem kh.


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ClindamycinClindamycin


Thng gap nhat la tieu chay.Thng gap nhat la tieu chay.

Co the boi nhiem vi cac chung viCo the boi nhiem vi cac chung vikhuan Clostridium difficile gay viem aikhuan Clostridium difficile gay viem aitrang mang gia.trang mang gia.


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ChloramphenicolChloramphenicol

Giong nh clindamycin, thuoc c hapGiong nh clindamycin, thuoc c hapthu tot va phan phoi khap ni trong cthu tot va phan phoi khap ni trong cthe bao gom ca than kinh trung ng.the bao gom ca than kinh trung ng.

Thuoc c chuyen hoa gan.Thuoc c chuyen hoa gan.

Mac du la khang sinh pho rong coMac du la khang sinh pho rong cohieu qua tot, nhng thuoc c shieu qua tot, nhng thuoc c sdung co gii han bi v tac dung phudung co gii han bi v tac dung phutram trong.tram trong.


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Thuoc thng c dung ieu trThuoc thng c dung ieu trviem mang nao do Haemophilusviem mang nao do Haemophilusinfluenzae, hay Neisseria menigitidis.influenzae, hay Neisseria menigitidis.

ac biet thuoc thng dung ieu trac biet thuoc thng dung ieu trRikettsia (sot ban).Rikettsia (sot ban).


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Tac dung phu hiem thieu mau.Tac dung phu hiem thieu mau.

Suy tuy do c che tuy co hoi phucSuy tuy do c che tuy co hoi phucdo c che s tong hp protein do c che s tong hp protein ngi.ngi.


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SulfoSulfonnamides va trimethoprimamides va trimethoprim

Ngay nay sulfonamides th t c sNgay nay sulfonamides th t c sdung n oc.dung n oc.

Sulfonamides thng c s dung ketSulfonamides thng c s dung kethp vi trimethhoprim e lam tanghp vi trimethhoprim e lam tangtac dung tieu diet vi khuan.tac dung tieu diet vi khuan.

Ca hai eu la thuoc diet khuan.Ca hai eu la thuoc diet khuan.


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SulfonamidesSulfonamides

Thuoc co cau tao giong paraThuoc co cau tao giong para--aminobenzoic acid, c che canh tranhaminobenzoic acid, c che canh tranhs tao thanh dihydropteroic acid.s tao thanh dihydropteroic acid.

Pho khang khuan: pho rong, tacPho khang khuan: pho rong, tacdung len ca vi khuan gram am vadung len ca vi khuan gram am vagram dng.gram dng.

Thng c s dung ieu trThng c s dung ieu trnhiem trung tieu, nhiem trungnhiem trung tieu, nhiem trungngoai tim. (ngoai tim. (NocardiaNocardia infections)infections)..


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TrimethoprimTrimethoprim

Thuoc ket hp vi men dihydrofolateThuoc ket hp vi men dihydrofolatereductase c che s tao thanhreductase c che s tao thanhtetrahydrofolic acid.tetrahydrofolic acid.

Pho khang khuan: pho rong tacPho khang khuan: pho rong tacdung len ca vi khuan gram am vadung len ca vi khuan gram am vagram dng.gram dng.

Thng c s dung ieu trThng c s dung ieu tr

nhiem trung tieu va nhiem trungnhiem trung tieu va nhiem trungngoai tim (ngoai tim (NocardiaNocardia infections)infections)..


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p-aminobenzoic acid + Pteridine

Dihydropteroic acid

Dihydrofolic acid

Tetrahydrofolic acid

Pteridine

synthetase

Dihydrofolate

synthetase

Dihydrofolate

reductase

Thymidine

Purines

Methionine

Sulfonamides

Trimethoprim


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Sulfonamide va trimethoprimSulfonamide va trimethoprim

Hau het cac sulfonamides hap thu totHau het cac sulfonamides hap thu totbang ng uong, phan phoi khapbang ng uong, phan phoi khapni trong c the ke ca he than kinhni trong c the ke ca he than kinhtrung ng.trung ng.

Thuoc c thai tr qua than diThuoc c thai tr qua than didang cha c chuyen hoa.dang cha c chuyen hoa.

Tac dung tren vi khuan gram dngTac dung tren vi khuan gram dngva nhieu vi khuan gram am.va nhieu vi khuan gram am.


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Sulfonamides va trimethoprimSulfonamides va trimethoprim

Trimethoprim cung hap thu tot bangTrimethoprim cung hap thu tot bangng uong, thai tr qua than vang uong, thai tr qua than vaco pho khang khuan giong nhco pho khang khuan giong nhsulfonamides.sulfonamides.

Cotrimoxazole c s dung ieu trCotrimoxazole c s dung ieu trnhiem trung tieu va nhiem trung honhiem trung tieu va nhiem trung ho

hap tren, nhng do thuoc co nhieuhap tren, nhng do thuoc co nhieutac dung phu do o nen tranh stac dung phu do o nen tranh sdung khi co the.dung khi co the.


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La thuoc c la chon e ieu trLa thuoc c la chon e ieu trva ngan nga viem phoi dova ngan nga viem phoi doPneumocystis cariniiPneumocystis carinii nhng ngi nhng ngi

suy giam mien dch.suy giam mien dch. Hien nay trimethoprim thng c sHien nay trimethoprim thng c s

dung e ieu tr nhiem trung tieudung e ieu tr nhiem trung tieu

hay nhiem trung ho hap tren, vhay nhiem trung ho hap tren, vthuoc co t tac dung phu hn dangthuoc co t tac dung phu hn dangket hp nhng hieu qua tng ng.ket hp nhng hieu qua tng ng.


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Tac dung phu:Tac dung phu: Roi loan tieu hoa.Roi loan tieu hoa.

Cac tac dung phu hiem hn nhngCac tac dung phu hiem hn nhng

nang hn: d ng, noi man, sot,nang hn: d ng, noi man, sot,giam bach cau, giam tieu cau,giam bach cau, giam tieu cau,thieu mau.thieu mau.

Thuoc co the lam giam chuyenThuoc co the lam giam chuyenhoa cua mot so thuoc nh:hoa cua mot so thuoc nh:phenytoin, wafarin, mot vai loai haphenytoin, wafarin, mot vai loai hang huyet dang uong, lam tangng huyet dang uong, lam tang


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QuinolonesQuinolones

Gom: nalidixic acid, ciprofloxacin,Gom: nalidixic acid, ciprofloxacin,ofloxacin, norfloxacin, levofloxacin,ofloxacin, norfloxacin, levofloxacin,lomefloxacin, sparfloxacin,lomefloxacin, sparfloxacin,

La thuoc diet khuan.La thuoc diet khuan. C che tac dung: ket hp vi DNAC che tac dung: ket hp vi DNA

gyrase c che s tong hp DNA cuagyrase c che s tong hp DNA cua

vi khuan.vi khuan. Pho khang khuan: chu yeu la viPho khang khuan: chu yeu la vi

khuan gram am, t co hieu qua oikhuan gram am, t co hieu qua oivi vi khuan yem kh.vi vi khuan yem kh.


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Nalidixic acid, quinolons the he auNalidixic acid, quinolons the he autien, thng ch c s dung ieutien, thng ch c s dung ieutr nhiem trung tieu di.tr nhiem trung tieu di.

Ciprofloxacin thuoc nhomCiprofloxacin thuoc nhomfluoroquinolones co pho khang khuanfluoroquinolones co pho khang khuanrong, chu yeu co tac dung tren trcrong, chu yeu co tac dung tren trc

trung gram am va Pseudomonas.trung gram am va Pseudomonas.


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Thuoc co the s dung ng uongThuoc co the s dung ng uonghoac tiem mach e ieu tr cac loaihoac tiem mach e ieu tr cac loainhiem trung bao gom nhiem trungnhiem trung bao gom nhiem trungho hap, nhiem trung tieu cung nhho hap, nhiem trung tieu cung nhviem phuc mac hoac Salmonella.viem phuc mac hoac Salmonella.

Thuoc t co tac dung oi vi viThuoc t co tac dung oi vi vi

khuan yem kh va khong nen chonkhuan yem kh va khong nen chonla thuoc au tien trong ieu trla thuoc au tien trong ieu trnhiem trung ng ho hap.nhiem trung ng ho hap.


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Tac dung phu:Tac dung phu: Roi loan tieu hoa.Roi loan tieu hoa.

D ngD ng

Fluoroquinolones co the c che chatFluoroquinolones co the c che chatdan truyen than kinh GABA, ieu naydan truyen than kinh GABA, ieu nayco the dan en lu lan ngi lnco the dan en lu lan ngi lntuoi.tuoi.

Thng khong c s dung choThng khong c s dung chongi b ong kinh.ngi b ong kinh.


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Gay ton thng s phat trien cuaGay ton thng s phat trien cuasun: chong ch nh s dung cho phusun: chong ch nh s dung cho phun co thai va tre em.n co thai va tre em.

Ciprofloxacin gay c che men chuyenCiprofloxacin gay c che men chuyenhoa gan va co the gay tng tachoa gan va co the gay tng tacco hai khi s dung chung vico hai khi s dung chung vi

theophylline, neu phan ng nang cotheophylline, neu phan ng nang cothe e doa tnh mang benh nhan.the e doa tnh mang benh nhan.

T t liT t li


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TetracyclinesTetracyclines

Gom: tetracycline, minocycline vaGom: tetracycline, minocycline vadoxycycline,doxycycline, La thuoc kiem khuan.La thuoc kiem khuan. C che hoat ong: ket hp vi tieuC che hoat ong: ket hp vi tieu

n v ribosome 30S, c che s taon v ribosome 30S, c che s taothanh protein cua vi khuan.thanh protein cua vi khuan.

Pho khang khuan: pho rong tacPho khang khuan: pho rong tac

dung tren nhieu loai vi khuan ngoaidung tren nhieu loai vi khuan ngoaitrtr Proteus va PseudomonasProteus va Pseudomonas, thng, thngdung ieu tr cac loai vi khuan hoatdung ieu tr cac loai vi khuan hoatong trong te bao.ong trong te bao.


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Nen s dung thuoc t nhat 30 phutNen s dung thuoc t nhat 30 phuttrc khi an.trc khi an.

Tetracyclines tap trung nhieu xng vaTetracyclines tap trung nhieu xng varang.rang.

Thai tr chu yeu qua nc tieu va 1Thai tr chu yeu qua nc tieu va 1phan qua mat.phan qua mat.

Hien nay co nhieu loai vi khuan eHien nay co nhieu loai vi khuan ekhang vi tetracyclineskhang vi tetracyclines


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Thuoc thng c s dung trong cacThuoc thng c s dung trong cactrng hp nhiem trung dotrng hp nhiem trung doMycoplasma, Rikettsia, Chlamydia vaMycoplasma, Rikettsia, Chlamydia va

Brucella.Brucella.

Hien nay nhom tetracyclines thngHien nay nhom tetracyclines thngc s dung e ieu tr mun, dungc s dung e ieu tr mun, dung

ng uong hoac tai cho.ng uong hoac tai cho.


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THAY OI MAU SAC RANG NGI S DUNG

TETRACYCLIN


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MetronidazoleMetronidazole

C che hoat ong: metronidazole ketC che hoat ong: metronidazole kethp vi DNA, c che s sao ma.hp vi DNA, c che s sao ma.

Thuoc hap thu tot sau khi uong hoacThuoc hap thu tot sau khi uong hoacnhet hau mon, va co the s dungnhet hau mon, va co the s dungtruyen tnh mach.truyen tnh mach.

Thuoc phan phoi khap ni trong cThuoc phan phoi khap ni trong cthe, gom ca nhng ni co abscess.the, gom ca nhng ni co abscess.

Thuoc c chuyen hoa gan.Thuoc c chuyen hoa gan.


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Thuoc con c s dung trong ieuThuoc con c s dung trong ieutr viem loet da day ta trang dotr viem loet da day ta trang doHelicobacter pyloris.Helicobacter pyloris.

Thuoc c s dung trong ieu trThuoc c s dung trong ieu trnhiem trung rang mieng, ac bietnhiem trung rang mieng, ac biettrong abscess rang.trong abscess rang.


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Buon non, chan an, co v kim loai.Buon non, chan an, co v kim loai.

That ieu.That ieu. nhng benh nhan uong ru co nhng benh nhan uong ru co

the xay ra phan ng kho chu, chothe xay ra phan ng kho chu, chonen khong nen uong ru trong lucnen khong nen uong ru trong lucang ieu tr.ang ieu tr.

co the gay quai thai neu s dungco the gay quai thai neu s dungthuoc trong tam ca nguyet au.thuoc trong tam ca nguyet au.


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NitrofurantoinNitrofurantoin

Thuoc thng dung ieu tr nhiemThuoc thng dung ieu tr nhiemtrung ng tieu, ac biet latrung ng tieu, ac biet lanhiem trung tieu di do vi khuannhiem trung tieu di do vi khuan

gram am.gram am.Hap thu tot bang ng uong, thaiHap thu tot bang ng uong, thaitr di cha chuyen hoa qua nctr di cha chuyen hoa qua nc

tieu.tieu.Thuoc ch co hieu qua khangThuoc ch co hieu qua khangkhuan khi tap trung trong nc tieu,khuan khi tap trung trong nc tieu,

cho nen thuoc khong co tac dungcho nen thuoc khong co tac dung


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NitrofurantoinNitrofurantoin

nhng benh nhan suy than, thuoc nhng benh nhan suy than, thuockhong co hieu qua do khong ckhong co hieu qua do khong cbai tiet nhieu trong nc tieu.bai tiet nhieu trong nc tieu.


Roi loan tieu hoa.Roi loan tieu hoa.

D ng.D ng.

Viem a day than kinh.Viem a day than kinh.


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FucidinFucidin

Fucidin ch co hieu qua trong ieuFucidin ch co hieu qua trong ieutr nhiem trung do Staphylococcustr nhiem trung do Staphylococcusaureus (c che s tong hp protein),aureus (c che s tong hp protein),

khong b pha huy bi menkhong b pha huy bi men FF--lactamase.lactamase.

Thuoc thng c s dung viThuoc thng c s dung vi

flucloxacillin e lam giam xuat hienflucloxacillin e lam giam xuat hiendong vi khuan khang thuoc.dong vi khuan khang thuoc.

Thuoc c hap thu tot va phanThuoc c hap thu tot va phan

bo rong khap ni trong c the kebo rong khap ni trong c the ke


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VancomycinVancomycin

C che hoat ong: c che s taoC che hoat ong: c che s taothanh vach te bao vi khuan.thanh vach te bao vi khuan.

Khong hap thu bang ng uong,Khong hap thu bang ng uong,

c s dung bang ng tiemc s dung bang ng tiemchch.chch. Thuoc c bai tiet qua than.Thuoc c bai tiet qua than.

Thuoc c s dung (truyen tnhThuoc c s dung (truyen tnhmach) trong nhng trng hp benhmach) trong nhng trng hp benhnang hay nhiem trung donang hay nhiem trung doStaphylococcus aureus, hay ieu trStaphylococcus aureus, hay ieu tr

viem noi tam mac nhng benhviem noi tam mac nhng benh


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Duoc Ly - 5.Khang Sinh

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